The article by O'Connor & Vize (Psychiatric Bulletin, December 2003, 27, ) highlights the need, as European working time directives become effective, to optimise the use of medical staff time. In psychiatry, a particular area of difficulty is related to the impact of physical morbidity in old age psychiatry wards on the work-load of psychiatry senior house officers (SHOs), especially out-of-hours.

In an East Anglia NHS hospital, we surveyed the referrals (112) received out-of-hours by the psychiatry SHO over a 30-day period, from two 20-bedded psychiatry wards (one old age, one general adult), accident and emergency or other hospital wards. Over 40% were from the old age psychiatry ward, and of these 30 (65%) were for assessment of physical illness. On seven occasions, patients referred for physical problems were found not to be acutely unwell by the psychiatry SHO, and on five, the SHO was called to administer ‘ nursing’ procedures (s/c fluids, heparin, catheter washout) or to organise transfer to medical beds for the administration of blood or IV fluids. Thus, our data suggest that some of these referrals could have been avoided, sparing SHO time for other commitments.

In an attempt to improve the use of SHO time out-of-hours, a voluntary training scheme is being considered at our hospital, which includes the regular exchange of nurses between the old age psychiatry ward and a twinned medical ward. It is hoped that this will result in reciprocal training and ‘ loan’ of specialist nursing skills, at no additional cost for staff or the Trust.